This document challenges the assumption that shoulder arthroscopy is an adequate gold standard for diagnosing long head biceps (LHB) tendon pathology. A cadaver study found that arthroscopy only allows visualization of a small portion of the extra-articular LHB tendon. A systematic review found the rate of missed LHB tendon diagnoses with arthroscopy alone is 30-50%. The document concludes that arthroscopy does not adequately evaluate the full LHB tendon for pathology and new arthroscopic techniques are needed to improve diagnosis.